MEDICARE: KATHERINE MARIE DEMIEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	9471356	ID
2	363LF0000X	Family Nurse Practitioner	79570	ID

General Provider Information

NPI Number	:	1265288773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MARIE DEMIEN

Provider Business Mailing Address
First Line	:	3815 N SCHREIBER WAY UNIT 102
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 N SCHREIBER WAY UNIT 102
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-667-4557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	12/13/2025

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Directions to “ KATHERINE MARIE DEMIEN ” Practice Location

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